Not Among Strangersby Valerie El Halta, CPM

How important is the impact of the birth environment upon achieving an optimal outcome of the birth process?

The environment in which birth takes place has an enormous impact upon birth outcome. Labor progress, pain tolerance, necessity for medical intervention, fetal well-being and satisfaction with the birth experience may all be directly related to the mother's sense of "safe place" in which she brings forth her baby.

"Safe place" has little to do with physical surroundings alone. Yet for many a woman, the home in which she resides, feels loved and secure, has prepared for her baby and "nested" most clearly defines that place. "Safe place" also has to do with the people with whom the woman feels most secure and comfortable. The interaction of the several personalities, which may be involved during labor and birth, may either positively or adversely affect the laboring woman's sense of "safe place." As we come to understand the importance of how these personalities impact the birth environment, we, as caregivers, become more sensitive to the needs of the mother as she approaches the time of labor and birth.

Traditionally, birth has been a very private affair in which only the most intimate of a woman's relations would attend the laboring woman. Grandmothers, aunts and wise women of the village whom the woman most trusted were the ones to be called. In today's society, women have been taught to place their trust in the medical model of childbirth and in medical professionals rather than in persons with whom they are most familiar. They are taught to accept the place of birth that the medical professional chooses (because it is the medical professional's "safe place"?). For many women this is a difficult and sometimes impossible transition, one which so impacts the sense of the familiar that patterns of labor are changed and the sensation of birth pain intensified. Outcome is made less predictable, and birth comes to be regarded as a difficult and painful ordeal, fraught with danger. Moreover, if the woman is confronted with an unfamiliar and therefore "not safe place," a survival mechanism will kick in. She will protect her baby by preventing it from being born by ceasing to contract, keeping her cervix closed and in general "failing to progress."

Those of us who are certain that a woman's home is the most suitable environment for her to give birth in must be particularly aware of the influence we may have on the woman's sense of safety. The most well meaning midwife may nonetheless be a "stranger" to the mother and a threat to her need for privacy if she has not become at one in trust with the woman well before labor ensues.

It is important for all midwives to develop the skills necessary to facilitate the best possible communication with their clients. Learning to establish a relationship of trust with the woman will do more to ensure an optimal outcome than taking classes in anatomy and physiology!

The successful midwife is the caring person who has learned to listen with both her mind and her heart, she who has mastered "the chameleon effect" of being able to integrate into the woman's environment without prejudice toward her lifestyle, race, religion or personal idiosyncrasies.

It is this empathetic midwife to whom the woman may turn in her hour of greatest need, who will be there for her whether that need be physiological or psychological. When the midwife is able to establish this level of trust between herself and her client, her presence at the time of labor will not conflict with the woman's privacy needs and will often have a dramatic influence on the progress and time lines of labor as well as on the woman's perception of labor pain.

If we could ask babies where they would like to be born, I wonder how many would answer: "Oh, in a hospital, of course! I want to be sure that I will be born amidst all modern technology has to offer in the event that an emergency should occur." Or, might they answer: "I want to be born in an environment of peace, security and joy and be received into the loving arms of my mother."

I wish that instead of a written article this were a video I could share with you as I remember one of many special homebirths. My friend Melinda was about to give birth to her ninth baby. This was to be her seventh that I was privileged to attend. I am her sister and her friend, and "Auntie Val" to all the kids. We had spent the day canning salsa and making my sour cream chicken enchiladas. Melinda was in the shower when she called out to me that the baby was coming!

Picture a woman at rest on a big waterbed, reclining in her husband's arms while eight brothers and sisters reverently encircle her, awaiting the moment of birth (Silent Night). As my hands and warm compresses soothe the mother's stretching tissues and the head begins to show, the youngest child, two-year-old Emily, says, "Oh! I can see the baby's head!" Then a deep giggle and, "I want to see my baby's head again!" The baby comes forth, looks all around, breathes quietly, and rests on his mommy's breast. Melinda sighs and says, "It is always so worth it." Dad gently touches the baby's head (Holy Night). The children all begin to sing a special family hymn to the baby as he continues to gaze at his mommy (All is Calm). Does he recognize the voices? Oh, I know he does, he has heard them all for months. Emily says, "There is a snake on the baby's tummy," and giggles again (All is Bright). There is plenty of time for cord cutting, weighing and measuring. Now is the time for being—he is home, he is safe, he is much loved. He has not been born among strangers.

It has been my experience that when the mother is able to labor in an environment of her choice, with persons surrounding her who make her feel respected, loved and safe, that she is free to "give birth to" rather than "be delivered of" her baby. Where else than in her own home, laboring with those she has chosen, should this most important event take place?